8, 9 April 2014
During an inspection in response to concerns
We were made aware during the inspection on the 8 April that the provider would no longer be operating at their registered location address with the CQC after 9 April 2014. The provider had not made application to register/add a new location as required. At the conclusion of our inspection the provider made arrangements to carry on providing the service without being correctly registered with CQC.
We were introduced to the manager (not registered with the CQC) who was in day to day control of the agency. We were told the Registered Manager was currently absent from their role. When we refer to the 'manager' in this report it is the person who was in day to day control of the service. Where we refer to the 'Registered Manager' this is the person who was registered with the CQC as manager.
Following the inspection we considered all of the evidence we had gathered under the standards we inspected. We used the information to answer the five questions we always ask:
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well led?
This is a summary of what we found-
Is the service safe?
People who used the service were not protected from the risk of abuse because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. We found evidence that the registered person did not respond appropriately to allegations of abuse and did not report the concerns directly to the Local Authority at the time they received information of concern.
We spoke with people during are inspection. One person we spoke with told us 'I am happy with the service and that's all that matters'.
We found that the agency had not made arrangements for the safe use and management of medicines, including the recording, handling and safe administration of medicines to people. Where people needed support with their medicines, this was not carried out by staff that had been suitably trained to administer medicines safely. Their on-going competence was not checked.
Records were not kept securely and could not be located promptly when needed. We were told some records of people and staff were not kept at the registered location. We also found evidence that some records were missing and had been lost.
Is the service effective?
People did not receive appropriate care and support because there were not effective systems in place to ensure that people's care needs were met. We saw that care plans had not been reviewed as a result of peoples changing needs.
Staff had not received training, supervision and support to ensure they understood people's needs and had the skills they need to provide the care.
We spoke with people during are inspection to see if people were happy with the service provided by the agency. One person we spoke with told us 'I am generally happy with them. Staff are good but recently they do seem short staffed'.
Is the service caring?
Where urgent issues were brought to the attention of the registered manager regarding the care and wellbeing of people the appropriate action was not taken. This showed that people were not treated with dignity and respect.
We spoke with people during are inspection to see if people were happy with the care provided by staff. One person we spoke with told us 'Yes' and confirmed they were happy with the care provided.
Is the service responsive?
Where concerns had been raised about people's wellbeing by staff we saw no evidence in peoples care records that advice was sought from healthcare professionals and the appropriate action taken. Changes in people's health conditions were not acted on and people were not monitored by staff.
We found when looking at care plans that they did not contain a comprehensive risk assessments of people's needs and did not contain sufficient information in order to ensure people's individual needs were met. Risk assessments had not been reviewed and did not state the identified risks, or how to manage those risks.
Is the service well led?
The Registered Manager was currently absent from their role and a day to day manager was control of the service. The registered person did not make the necessary applications to CQC to change their registration as required.. Staff and people that used the service were not made aware of the change of address and the appropriate action was not taken.
The registered person had not ensured that there was a system in place to address staffing shortfalls. We found there were not enough staff to care for people and visits were not completed in relation to people's assessed needs.
The registered manager was carrying out the training for staff but had not received the necessary training to do this safely. They had not undertaken specific catheter care training.